How to Recognize a Functional Alcoholic

A "functional alcoholic" (or "high-functioning alcoholic") isn't a formal medical diagnosis, but a term used colloquially to describe a person who is dependent upon alcohol but can still function in society. The term “currently-functioning" may be used since it’s not likely they will remain functional (and not misuse alcohol) indefinitely.

Drinking rarely causes them to miss work and other obligations (although it does happen occasionally). They are usually able to manage areas of life including jobs, homes, and families.

They often appear physically and mentally healthy. However, they are likely struggling with uncontrollable cravings, unsuccessful attempts at quitting, and obsessive thoughts about their next drink—all hallmarks of an alcohol use disorder.

Risk Factors for Functional Alcoholics

According to the National Institutes of Health, functional alcoholics are typically "middle-aged, well-educated, with stable jobs and families." While the causes are not known, there are risk factors that increase your chances of developing a problem with alcohol, including:

• Binge drinking (more than 5 drinks per day)
• Experiencing high levels of stress
• Exposure to peer pressure to drink
• Having a parent or close relative with an alcohol use disorder
• Having a mental health problem, such as anxiety, depression, or schizophrenia
• Having low self-esteem
• Having more than seven drinks (for females) or more than 14 drinks per week (for males) 

Signs of a Functional Alcoholic

Could it be that you have an alcohol use disorder even though you continue to function well in society? Could your drinking have slowly increased to the point that you have become alcohol dependent without even knowing it?

Here are some red flags that signal you need help:

• Are you the first one at the bar after work, or do you pour yourself a drink when you come home?
• Do you get agitated, irritable, or nervous if a meeting or other occurrence prevents you from having a drink?
• Are there often times when you drink more or longer than you intended?
• Do you tend to joke about alcoholism? For example: "I'm a drunk, alcoholics go to meetings."
• Do you constantly talk about drinking or brag about stockpiling liquor so there's "enough" alcohol available?
• Do you “drink” your meals or use mealtime as an excuse to start drinking? 
• Have you engaged in any high-risk behaviors (even if you never got caught), including binge drinking, driving under the influence, drinking while caring for your children, or practicing unsafe sex?
• Has a loved one ever confronted you about drinking? Did it make you feel angry or irritated?
• Have you ever experienced an alcohol-related blackout, during which you could not remember parts of the night or how you got home?
• Has your drinking caused any relationship problems?
• Have you ever hidden your alcohol consumption?
• Do you experience withdrawal symptoms when you're unable to drink alcohol?

Denial

One of the main reasons that people who misuse alcohol seek help is the eventual negative consequences of their alcohol consumption. When the pain or embarrassment gets bad enough, they can no longer deny that their drinking needs to be addressed.

For the functional alcoholic, the denial runs deep, because they have yet to encounter significant negative consequences. They go to work every day. They haven't suffered financially. They have never been arrested.

They tell themselves that don't have a problem. Listen for excuses:

• “I have a great job and pay my bills, so I can’t have a problem with alcohol.”
• “I only drink expensive wine.”

Tolerance

A functional alcoholic often consumes as much alcohol as someone with an alcohol use disorder. However, they will not exhibit outward symptoms of intoxication.

This is because they have developed a tolerance for alcohol to the point that it takes more for them to feel the effects (including hangovers). Consequently, they must drink increasingly larger amounts to get the same "buzz" they want.

This slow build-up of alcohol tolerance means the functional alcoholic is drinking at dangerous levels that can result in:

• Alcohol dependence
• Alcohol-related organ damage
• Cognitive impairment

Withdrawal

Unfortunately, even when functional alcoholics begin to recognize that they have a drinking problem, they still resist reaching out for help. By the time they admit the problem, their withdrawal symptoms—which can begin within a few hours after their last drink—can become more and more severe.

Symptoms of alcohol withdrawal include:

• Anxiousness or nervousness
• Appetite loss
• Depression
• Difficulty sleeping
• Dilated pupils
• Faster heart rate
• Fatigue or tiredness
• Headache
• Irritability
• Mood swings
• Nausea and/or vomiting
• Nightmares
• Not being able to think clearly
• Pale skin
• Shakiness
• Sweating
• Tremor

They may try to quit independently, but the withdrawals are too unpleasant or severe. Therefore, they continue to drink to keep the withdrawals at bay, and the cycle continues.

Usually, it is only when their continued drinking becomes more painful than the prospect of going through the pain of alcohol withdrawal, will they finally reach out for help. But it doesn't have to be that way. Help is available.

Impact of Being a Functional Alcoholic

While a person who is high-functioning alcohol can still fulfill their obligations in many areas of life, that does not mean that their drinking does not take a toll on their health, relationships, career, and well-being.

In the short term, alcohol use increases the risk for alcohol poisoning, fetal alcohol syndrome, accidents, injuries, violence, and risky sexual behavior.

Alcohol intake also has long-term consequences, including an increased risk of:

• Alcohol dependence and alcohol use disorders
• Certain types of cancer, including breast, mouth, liver, colon, and throat
• Memory and learning problems
• Mental health conditions such as anxiety and depression
• Weakened immunity

In addition to the health effects of having an alcohol use disorder, it can also take a toll on relationships. Drinking doesn't just affect the individual; it affects the entire family unit.

Family members may feel on edge and worried about their loved ones drinking. They may take steps to avoid the person while they are drinking, or they may experience feelings of guilt, shame, or self-blame. 

Coping With a Functional Alcoholic

If you are concerned about your loved one's drinking, it can be helpful to join a support group such as Al-Anon. Such groups can offer valuable support, encouragement, advice, and information.

While a functional alcoholic can still function in daily life, family members and loved ones are often aware and concerned about the individual's alcohol use. Some steps you can take to help include:

• Learn more about alcohol use disorders
• Joining a support group
• Talk to the person about your concerns in a calm and non-accusatory way
• Learn about community reinforcement and family training (CRAFT), which is a way that can help family members support a loved one's addiction recovery
• Learn how to stop enabling and co-dependent behaviors

The National Institute of Health suggests that loved ones should start by talking about their concerns. Avoid accusing, blaming, or making threats. Instead, voice your concerns, share how their drinking is affecting others, and suggest ways that you can help them talk to a doctor or join a support group.

Getting Help As a Functional Alcoholic

If you are having only mild to moderate withdrawal symptoms, your healthcare provider may recommend outpatient treatment, including medical detoxification that provides medication, vitamins, and diet to help ease the withdrawal process.

Your provider can also perform tests to see if you have developed any medical concerns from alcohol misuse and recommend counseling, rehabilitation, and support groups like Alcoholics Anonymous or SMART Recovery.